Manager, Payor Relations

Infucare Rx Inc on behalf of itself and its subsidiaries

About The Position

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting. We have created an ethical, team oriented, and quality work environment for our employees that cultivates achievement and success. The Manager, Payor Relations, will be the subject matter expert (SME) supporting RCM and Intake to ensure InfuCare Rx is compliant with all payor requirements; inclusive of but not limited to clinical guidelines and/or payment policies, contract terms and conditions. The Manager, Payor Relations will work with all functional areas to resolve, manager and escalate (with approval from the RDMC) all payor issues impacting the payment of claims for assigned accounts.

Requirements

Bachelor's degree preferred, high school diploma and/or equivalent work experience required.

Nice To Haves

Experience working in the acute or specialty pharmacy industry.
Experience working for national or regional payor or managed care entity.
Ability to understand, read, write, speak effectively to commicate concepts.
Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to successfully write business correspondence.
Ability to recognize and define problems, collect data, establish facts, draw valid conclusions, and correct errors. Ability to understand and interpret basic financial data. Ability to interpret a variety of instructions in a variety of forms and deal with abstract and concrete variables.
Must be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner.
Must be able to work well with and create/present material to others. Strong verbal and written communication skills required.
Must be detail-oriented and organized. High integrity, including maintenance of confidential information.
Based on business need, the ability to work a flexible schedule.

Responsibilities

Act as a Payor Liaison between ICRX RCM and Intake for payers as assigned.
Account responsibilities include but not limited to the following:
Identify and manage payment (over/under) and/or denial issues not resolved through the normal claims' escalation processes to payor(s).
Upon identification of issues, root cause and determine steps for resolution by escalating to the payer.
Work with the National Director Contracting in the development of account specific A/R metrics to measure the improvement and management of the A/R with all assigned payers.
Work with RCM to establish and work ongoing claims projects to ensure improved claims payment by minimizing claims denial.
Support training and tools/resources as needed to ensure Intake and RCM meet all contract requirements.
Work with RCM/Contracting leadership to manage claims issues through approved reporting application and escalation to payor as needed.
Manage monthly RCM Escalation Tracker calls.
Support the National Director of Contracting and Manager, Payor Relations with the creation, maintenance and implementation of comprehensive billing guides, quick reference guides, FAQs to assist with daily workflow processes for intake, billing and collections.
Maintain national demographics for assigned accounts.
Manage Waystar/Payor EFT/EDI/ERA set up with RCM to ensure proper electronic billing set up and to improve billing accuracy.
Other duties as assigned by manager.